3 years out - officially a millionaire and one step closer to saying goodbye to EM

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HemorrhagicShock said:
Yea, I left the ED permanently a few months ago (just before respiratory hell season hit) and it's done wonders for my life.

Outside of rent, I have a very low COL situation for me and my family, and I got to my "FIRE" number early in 2024. Ran the numbers, and worked a little bit more to ensure a little icing on top of that cake, and finally pulled the plug.

I'm now just trying to figure out how I can use my physician experience, license, and medical-know-how to start or do some side hustle that I can build out into a main hustle.

But I'm currently having the problem of finding anybody who wants to pay an ER doctor for ANYTHING that isn't generating RVUs in an ER.

UR/UM remote work, med mal expertise stuff, case review, urgent care, expert network stuff (GLG etc), pharma remote jobs.

Can't find anything that will pay me a 1099 income. Not a single bite despite over 100 applications sent out.
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so w2 offers are out there? how many years did you practice that could have some role in UR/UM/case review/expert etc?

Would you consider prn ED work at some point until some of these other offers works out?
 
finalpsychyear said:
so w2 offers are out there? how many years did you practice that could have some role in UR/UM/case review/expert etc?

Would you consider prn ED work at some point until some of these other offers works out?
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No, W2 offers are definitely not out there, but the only offer I will entertain for any kind of work is 1099. I have a nice corporate structure that I've engineered for myself and it only works from a tax efficiency standpoint if I have a 1099 income

I'd only consider PRN EM work if I could get a low volume low acuity PRN ED job, but they effectively don't exist anywhere near me and at minimum would require 3-4 hours of driving
 
sloh said:
The stuff Bryan Johnson promotes is analogous to people promoting fully body MRI’s. Every time you run a placebo controlled trial on regen med potions the results are either null or clinically not meaningful. Placebo is strong.
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Slap a $10,000 per injection price tag on that Placebo and suddenly you have plenty of people lining up...

Crazy how that works...
 
HemorrhagicShock said:
Yea, I left the ED permanently a few months ago (just before respiratory hell season hit) and it's done wonders for my life.

Outside of rent, I have a very low COL situation for me and my family, and I got to my "FIRE" number early in 2024. Ran the numbers, and worked a little bit more to ensure a little icing on top of that cake, and finally pulled the plug.

I'm now just trying to figure out how I can use my physician experience, license, and medical-know-how to start or do some side hustle that I can build out into a main hustle.

But I'm currently having the problem of finding anybody who wants to pay an ER doctor for ANYTHING that isn't generating RVUs in an ER.

UR/UM remote work, med mal expertise stuff, case review, urgent care, expert network stuff (GLG etc), pharma remote jobs.

Can't find anything that will pay me a 1099 income. Not a single bite despite over 100 applications sent out.
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How many years have you been an EM doc? How are you supporting yourself now?

Have you reached FIRE? What is the number?
 
finalpsychyear said:
Im at least open to the idea but need more data and im talking about 5 years from now at the earliest so depends what it looks like.

Bone broth plus collagen powder took away my joint/knee pain from playing singles tennis 2-3x a week on hard court. Told my ortho/pmr friends who are my tennis buddies they said theres no data to back it up. Then they started having issues and tried it themselves and got results and dont know what to say.

Regardless, sleep, exercise (wts/cardio/interval), low processed/fresh food diet, meditation and then fasting (all variants have a role) i'd argue are going to be 90-95% of the answer to lasting longevity regardless.


P.S. maybe i misread but were you able to take time away from the grind due to hitting FIRE?
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I struggle to see how bone broth plus collagen peptides is substantially different than just supplementing more protein. Unless somehow the leucine deficient protein somehow shunts the collagen to joints more.
 
sloh said:
The stuff Bryan Johnson promotes is analogous to people promoting fully body MRI’s. Every time you run a placebo controlled trial on regen med potions the results are either null or clinically not meaningful. Placebo is strong.
Click to expand...
I like the full body cancer screening MRI. I've done it twice and will continue to do it.
 
TooMuchResearch said:
I struggle to see how bone broth plus collagen peptides is substantially different than just supplementing more protein. Unless somehow the leucine deficient protein somehow shunts the collagen to joints more.
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theres some interesting research in regards to the protein we typically are eating from meat is absent the tendons, ligaments, cartilage/bone that alot of the collagen peptides are directly from. Apparently combining them may be providing additional benefits since we are selectively only eating the flesh absent those other parts and dont forget the bone as well. Even before bone broth plus collagen I have typically gotten 150-170 grams of protein most of the time but i feel more recovered in the joints/ligaments which i cant really explain unless you play on those concrete or unatural substances.
 
finalpsychyear said:
theres some interesting research in regards to the protein we typically are eating from meat is absent the tendons, ligaments, cartilage/bone that alot of the collagen peptides are directly from. Apparently combining them may be providing additional benefits since we are selectively only eating the flesh absent those other parts and dont forget the bone as well. Even before bone broth plus collagen I have typically gotten 150-170 grams of protein most of the time but i feel more recovered in the joints/ligaments which i cant really explain unless you play on those concrete or unatural substances.
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"Grind your bones to make my bread."
 
Back to the original discussion. Find a retirement calculator.. Save 70K a year.. really should be more cause IMO you have to do a backdoor roth.. Call it save 80k a year.. If you start at age 35 you will have $5m in cash (outside of your house) .. can spend a ton along the way and enjoy life. Ideally you save more.. i am guessing many on here do.. But even that “bare” minimum will get you free and let you enjoy life along the way. If you find an exceptional job or do high paying locums you can save 200-300k a year. You will get rich quick..

As above, take care of yourself and each other.. having a ton of money but lacking your health is a worse outcome than being broke and healthy IMO.
 
EctopicFetus said:
I dont do the MRI screening.. but whats the downside? Or is it just that you think it’s a waste of $$?
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I don't see much of a downside.
I've had similar passing thoughts.
I thought I was weird for thinking that.

Downside? I mean, iatrogenic harm somehow from a false positive? Somehow??
 
TooMuchResearch said:
I like the full body cancer screening MRI. I've done it twice and will continue to do it.
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I have thought about this but the worry is if I find something, it would just cause stress for the family and more workup. Can you give me more insight into this such as cost, and pitfalls?
 
RustedFox said:
For real?
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Yes.
Will it replace other screening? No.
Will it potentially tell you early if there is something brewing in the prostate or other organ? Yes.
Can I afford it? Yes.
What's the risk (to someone that knows what to do with the information)? I see little.
Similar reason as to why I pay for my parents and in-law to get Galleri liquid biopsy cancer screening annually.
 
emergentmd said:
I have thought about this but the worry is if I find something, it would just cause stress for the family and more workup. Can you give me more insight into this such as cost, and pitfalls?
Click to expand...
As a rad, find a private imaging center and pay cash for diagnostic exams covering the areas you want to screen. These screening places use blah imaging protocols for throughput and still charge you the same you'd pay if you went this route for diagnostic exams. I've seen some pretty bad prenuvo misses because their image quality is not good...
 
EctopicFetus said:
I dont do the MRI screening.. but whats the downside? Or is it just that you think it’s a waste of $$?
Click to expand...

Wait are you guys seriously considering this? I thought you guys were joking lol.

“All tumors start in a target organ (breast, lung or colon). The first grow slowly and are unlikely to shed cells elsewhere. These are not going to kill you in your natural life. You might feel them with your hand someday and cut them out, but even if you didn’t, you have nothing to worry about.

The second are those that spread microscopic cells very early on. Even if you find them when small, they have seeded other organs. There is almost nothing you can do to avoid dying by this cancer short of removing all your organs prophylactically— but then you have other issues. If you find this tumor and cut it out and take chemo— you still die of that cancer— but with a few more surgeries and more time on chemo than had you found it later.

The third type of tumor is the tumor that starts in the target organ, and was going to spread, and going to kill you, but because you find it and cut it out, you live much longer than you otherwise would. This is what we want to find!

Now consider that all three are indistinguishable under the microscope. All get the same treatment— surgery, radiation, and chemotherapy.

The problem is that finding tumors #1 and #2 is not good for you. You are subject to surgery, radiation and chemotherapy that you don’t need. These interventions can improve survival when done appropriately, but when done on people who don’t need them, result in a net loss of survival. Your life is shorter and worse off if you got these treatments when you can’t benefit.

Finding #3 is great, and I wish we could find selectively.”

www.drvinayprasad.com

Why you should NOT get a whole body MRI

Even if it & all downstream testing were free, I would say no. It is a bad idea.
www.drvinayprasad.com www.drvinayprasad.com
 
sloh said:
Wait are you guys seriously considering this? I thought you guys were joking lol.

“All tumors start in a target organ (breast, lung or colon). The first grow slowly and are unlikely to shed cells elsewhere. These are not going to kill you in your natural life. You might feel them with your hand someday and cut them out, but even if you didn’t, you have nothing to worry about.

The second are those that spread microscopic cells very early on. Even if you find them when small, they have seeded other organs. There is almost nothing you can do to avoid dying by this cancer short of removing all your organs prophylactically— but then you have other issues. If you find this tumor and cut it out and take chemo— you still die of that cancer— but with a few more surgeries and more time on chemo than had you found it later.

The third type of tumor is the tumor that starts in the target organ, and was going to spread, and going to kill you, but because you find it and cut it out, you live much longer than you otherwise would. This is what we want to find!

Now consider that all three are indistinguishable under the microscope. All get the same treatment— surgery, radiation, and chemotherapy.

The problem is that finding tumors #1 and #2 is not good for you. You are subject to surgery, radiation and chemotherapy that you don’t need. These interventions can improve survival when done appropriately, but when done on people who don’t need them, result in a net loss of survival. Your life is shorter and worse off if you got these treatments when you can’t benefit.

Finding #3 is great, and I wish we could find selectively.”

www.drvinayprasad.com

Why you should NOT get a whole body MRI

Even if it & all downstream testing were free, I would say no. It is a bad idea.
www.drvinayprasad.com www.drvinayprasad.com
Click to expand...
Don't take anything Vinay Prasad says seriously. He is a professional troll.
 
EctopicFetus said:
Back to the original discussion. Find a retirement calculator.. Save 70K a year.. really should be more cause IMO you have to do a backdoor roth.. Call it save 80k a year.. If you start at age 35 you will have $5m in cash (outside of your house) .. can spend a ton along the way and enjoy life. Ideally you save more.. i am guessing many on here do.. But even that “bare” minimum will get you free and let you enjoy life along the way. If you find an exceptional job or do high paying locums you can save 200-300k a year. You will get rich quick..

As above, take care of yourself and each other.. having a ton of money but lacking your health is a worse outcome than being broke and healthy IMO.
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If we are assuming the s and p 500 gives us 10% returns and inflation stays at 3 percent as an average for the next 20 years,
then investing 115k including all 401k, ira, match, etc would take you 20 years or the age of 55 if you started at 35 but you would hit 5m. Personally, for me I am hoping/wishing it can happen in the 45-50 year range bc that time and youth outweighs alot even if its a smaller number.

I'll be honest, I think if possible shoot for more esp those early years which yes will require hustle but you will be in your prime years. If i was in ER do i really want to be putting my body through nights, wknds, holidays, swing shifts into my 50s? We want high liquid NW with the youngest age and still sorta live in the moments (trips, events, wknds with family) bc well anything can happen.
 
Like everything in life, you have to make decisions based on what you know and educate yourself on how to deal with information.

I would never recommend full body for the general population b/c most are irrational and would have a profound negative affect.

I rather have information and allow me to make educated decisions so more info the better. Even if an MRI showed a questionable tumor, it would not affect my psyche but allow me to do follow up MRIs then make a more educated decision.

i have thought about this in the past and I think my early 50's is a good time to do a 1st look.
 
sloh said:
Wait are you guys seriously considering this? I thought you guys were joking lol.

“All tumors start in a target organ (breast, lung or colon). The first grow slowly and are unlikely to shed cells elsewhere. These are not going to kill you in your natural life. You might feel them with your hand someday and cut them out, but even if you didn’t, you have nothing to worry about.

The second are those that spread microscopic cells very early on. Even if you find them when small, they have seeded other organs. There is almost nothing you can do to avoid dying by this cancer short of removing all your organs prophylactically— but then you have other issues. If you find this tumor and cut it out and take chemo— you still die of that cancer— but with a few more surgeries and more time on chemo than had you found it later.

The third type of tumor is the tumor that starts in the target organ, and was going to spread, and going to kill you, but because you find it and cut it out, you live much longer than you otherwise would. This is what we want to find!

Now consider that all three are indistinguishable under the microscope. All get the same treatment— surgery, radiation, and chemotherapy.

The problem is that finding tumors #1 and #2 is not good for you. You are subject to surgery, radiation and chemotherapy that you don’t need. These interventions can improve survival when done appropriately, but when done on people who don’t need them, result in a net loss of survival. Your life is shorter and worse off if you got these treatments when you can’t benefit.

Finding #3 is great, and I wish we could find selectively.”

www.drvinayprasad.com

Why you should NOT get a whole body MRI

Even if it & all downstream testing were free, I would say no. It is a bad idea.
www.drvinayprasad.com www.drvinayprasad.com
Click to expand...

This post is such a home-run

It's absurd that physicians, despite rationally and intelligently understanding what's written, still have emotions take over and fall for stuff like this. I 100% understand why too; it's the same idea behind why Steve Jobs thought he could buy his way out of pancreatic cancer using his own hubristic approach.

Tragic, honestly, but it rewards those who can genuinely see the signal for the noise.
 
sloh said:
He can go off the deep end with Covid related topics but that’s quite broad of a brush to paint.

Anyways I don’t mean to derail this thread so I will stop commenting on this topic after this post
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why do you think his covid takes are “off the deep end” but his cancer screening or diagnostic ones aren’t?

HemorrhagicShock said:
This post is such a home-run

It's absurd that physicians, despite rationally and intelligently understanding what's written, still have emotions take over and fall for stuff like this. I 100% understand why too; it's the same idea behind why Steve Jobs thought he could buy his way out of pancreatic cancer using his own hubristic approach.

Tragic, honestly, but it rewards those who can genuinely see the signal for the noise.
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His argument is nonsensical: can’t tell them apart so why even try. Regardless of the false assertion that they are “identical”.

I fail to see the relevance of Steve Jobs. He tried to avoid treatment. People seeking out screening *want to act*. Compare to active smokers who avoid lung cancer screening (even more effective than mammo+colo combined).

Active surveillance is a thing. It’s a personal choice. The notion that “even looking for disease is bad” is a weird take, perfect for a professional contrarian.
 
RustedFox said:
I don't see much of a downside.
I've had similar passing thoughts.
I thought I was weird for thinking that.

Downside? I mean, iatrogenic harm somehow from a false positive? Somehow??
Click to expand...
I think it's hard to get a true false positive on diffusion weighted MRI read by radiologist + AI with large and ever growing data set.

I learned a few things about my body that don't matter and don't limit me. No solid organ tumors were detected.

MRI as we all know is still not great at finding everything, more likely I think to miss small lung tumors but I'd have to double check.

Prenuvo does diffusion weighted MRI. This is what I've done. I think they have 6-8 US locations now.
Ezra is another option. I don't know what they use for MRI sequences. They also offer a low dose chest CT and might do CT corony studies. I'm probably too young to need to care about those but am a former smoker so might convince myself to go for it.


I think the same way about labs. I put together a list of things I think should be evaluated annually beyond what a standard primary care visit would offer and order them through Ulta Lab Tests and get them done at a local lab. For $500, I get labs that a clinic would probably charge $2k for and have easy access to track the data.

I would happily pay out of pocket for an early screening colonoscopy if they would use light sedation and not charge whatever several thousand dollar number they charge.

What's the recommended age for screening colonoscopy these days? 45?
What about upper endoscopy for family history of esophageal and pancreatic cancer? These are questions I will ask the internet.
 
emergentmd said:
I have thought about this but the worry is if I find something, it would just cause stress for the family and more workup. Can you give me more insight into this such as cost, and pitfalls?
Click to expand...
Data doesn't scare me. A positive finding warrants evaluation before it's a metastatic cancer. If it's something benign, great.

Prenuvo is $2500. I'm sure I can get some $300 off friends and family coupons as a customer but I think you can afford full price.

They found a couple of likely hemangiomas on my first scan. Report clearly says most consistent with hemangioma, provides a thorough description of what that means and that it doesn't need further workup.

The reports are given for lay people but do include all findings.
 
maxxor said:
As a rad, find a private imaging center and pay cash for diagnostic exams covering the areas you want to screen. These screening places use blah imaging protocols for throughput and still charge you the same you'd pay if you went this route for diagnostic exams. I've seen some pretty bad prenuvo misses because their image quality is not good...
Click to expand...
Can I just call a private imaging center and ask for studies? Or ask them if I can write my own orders?
 
There are some that accept patient self referral. Depends on the local state laws. Similar to patient requested lab testing.

It’s legal in my state.
 
sloh said:
Wait are you guys seriously considering this? I thought you guys were joking lol.

“All tumors start in a target organ (breast, lung or colon). The first grow slowly and are unlikely to shed cells elsewhere. These are not going to kill you in your natural life. You might feel them with your hand someday and cut them out, but even if you didn’t, you have nothing to worry about.

The second are those that spread microscopic cells very early on. Even if you find them when small, they have seeded other organs. There is almost nothing you can do to avoid dying by this cancer short of removing all your organs prophylactically— but then you have other issues. If you find this tumor and cut it out and take chemo— you still die of that cancer— but with a few more surgeries and more time on chemo than had you found it later.

The third type of tumor is the tumor that starts in the target organ, and was going to spread, and going to kill you, but because you find it and cut it out, you live much longer than you otherwise would. This is what we want to find!

Now consider that all three are indistinguishable under the microscope. All get the same treatment— surgery, radiation, and chemotherapy.

The problem is that finding tumors #1 and #2 is not good for you. You are subject to surgery, radiation and chemotherapy that you don’t need. These interventions can improve survival when done appropriately, but when done on people who don’t need them, result in a net loss of survival. Your life is shorter and worse off if you got these treatments when you can’t benefit.

Finding #3 is great, and I wish we could find selectively.”

www.drvinayprasad.com

Why you should NOT get a whole body MRI

Even if it & all downstream testing were free, I would say no. It is a bad idea.
www.drvinayprasad.com www.drvinayprasad.com
Click to expand...
Tell it to all the very young people that we tell most likely have metastatic cancer.
The goal is to avoid this for myself and my family.
 
If someone can afford this, why not get some more information. Do an MRI, see a small questionable whatever, then you can repeat it in 6 months or a year. Its not like I am going to have every small questionable thing biopsied.

1-2K is chump change to docs, why not have the data. I rather Know of a small lesion that grows and monitor than not know at all. It is against my nature to put my head in the sand.
 
I honestly thought this "whole body scan" thread going on here was a joke. I honestly can't believe there's physicians here that would use this strategy for themselves. And then repeat q6-12 months?! Ok you find a 1cm adrenal nodule or whatever prostate thing. Now what? You're gonna get a PSA? Which is fraught w crap data. Then you're gonna get a transrectal biopsy? Hopefully you don't get bacteremic.
emergentmd said:
If someone can afford this, why not get some more information. Do an MRI, see a small questionable whatever, then you can repeat it in 6 months or a year. Its not like I am going to have every small questionable thing biopsied.

1-2K is chump change to docs, why not have the data. I rather Know of a small lesion that grows and monitor than not know at all. It is against my nature to put my head in the sand.
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WhatJobDoIPick said:
I honestly thought this "whole body scan" thread going on here was a joke. I honestly can't believe there's physicians here that would use this strategy for themselves. And then repeat q6-12 months?! Ok you find a 1cm adrenal nodule or whatever prostate thing. Now what? You're gonna get a PSA? Which is fraught w crap data. Then you're gonna get a transrectal biopsy? Hopefully you don't get bacteremic.
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Because in the end most physicians are like most patients. There's a reason there's no data (at least that I'm aware of) that executive physicals really alter mortality.
 
JacobMcCandles said:
Because in the end most physicians are like most patients. There's a reason there's no data (at least that I'm aware of) that executive physicals really alter mortality.
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@WhatJobDoIPick I havent done one of these things but I would say a few things. As a screening tool what they show is a lack of value with regards to money/ cost. The difference is docs are both wealthy and understand these results better than most.

Sure you may get an incidentaloma and go down a rabbit hole and get a Bx and become septic. However, more likely you will find nothing, be reassured and go about your day. Even more likely is you find some other mild finding and you can decide what to do. The screening is not cost effective which is different than being totally stupid.

We have all seen a patient with Mets and a new dx of cancer. If that same Dx was made 6 months earlier things would be different for that patient.
 
WhatJobDoIPick said:
I honestly thought this "whole body scan" thread going on here was a joke. I honestly can't believe there's physicians here that would use this strategy for themselves. And then repeat q6-12 months?! Ok you find a 1cm adrenal nodule or whatever prostate thing. Now what? You're gonna get a PSA? Which is fraught w crap data. Then you're gonna get a transrectal biopsy? Hopefully you don't get bacteremic.
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Actually if you found something concerning on the prostate MRI you would see a urologist who may get a higher fidelity dedicated prostate MRI rather than a tissue biopsy.
 
EctopicFetus said:
@WhatJobDoIPick I havent done one of these things but I would say a few things. As a screening tool what they show is a lack of value with regards to money/ cost. The difference is docs are both wealthy and understand these results better than most.

Sure you may get an incidentaloma and go down a rabbit hole and get a Bx and become septic. However, more likely you will find nothing, be reassured and go about your day. Even more likely is you find some other mild finding and you can decide what to do. The screening is not cost effective which is different than being totally stupid.
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FWIW, there are actually data out there that surveillance imaging (CT, PET, MRI) in people with a history of early stage (I-III) breast cancer treated with curative intent not only does not increase rate of identification of metastatic disease over symptom based imaging but does in fact lead to increased morbidity and cost.
EctopicFetus said:
We have all seen a patient with Mets and a new dx of cancer. If that same Dx was made 6 months earlier things would be different for that patient.
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I mean, if we had a time machine and could go back and do a CT scan 6 months prior...maybe. if we knew what we were looking for. But just to sight a few examples, a standard contrast enhanced CT CAP or MRI has a low likelihood of picking up a primary esophageal, gastric, pancreatic or colon cancer. But picking up the mets in the liver or lung is relatively easy. So a "clean" scan is not in any way a guarantee that a cancer is not lurking.

Early cancer detection is a huge area of research, but for most cancers, imaging based screening has been a bust (CT chest for lung and mammograms for breast being notable exceptions).
 
You also need to contend with the fact that among currently available screening tests for diseases where death is a common outcome, reductions in disease-specific mortality are uncommon and reductions in all-cause mortality are very rare or non-existent.

 
gutonc said:
FWIW, there are actually data out there that surveillance imaging (CT, PET, MRI) in people with a history of early stage (I-III) breast cancer treated with curative intent not only does not increase rate of identification of metastatic disease over symptom based imaging but does in fact lead to increased morbidity and cost.

I mean, if we had a time machine and could go back and do a CT scan 6 months prior...maybe. if we knew what we were looking for. But just to sight a few examples, a standard contrast enhanced CT CAP or MRI has a low likelihood of picking up a primary esophageal, gastric, pancreatic or colon cancer. But picking up the mets in the liver or lung is relatively easy. So a "clean" scan is not in any way a guarantee that a cancer is not lurking.

Early cancer detection is a huge area of research, but for most cancers, imaging based screening has been a bust (CT chest for lung and mammograms for breast being notable exceptions).
Click to expand...

Ideal BMI, Real cooked foods, 7-8 hrs sleep, 1 hr cardio/weights 4-5 days. get a trainer/nutrtionist. meditate. Do fasting. dont drink or smoke. Live in a low pollution area. Good social connection/relationships.

Just cured 99% of cancers and dz. But 90% of people wont do this. We live in a society that wants their cake and eat it too.
 
finalpsychyear said:
Ideal BMI, Real cooked foods, 7-8 hrs sleep, 1 hr cardio/weights 4-5 days. get a trainer/nutrtionist. meditate. Do fasting. dont drink or smoke. Live in a low pollution area. Good social connection/relationships.

Just cured 99% of cancers and dz. But 90% of people wont do this. We live in a society that wants their cake and eat it too.
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I'm with you, except for that last part.

What if I just want to be a rich hermit who has completely lost faith in the human race and is no longer surprised that every single human being in your life will let you down in some way or another?

I understand all the data on happiness and longevity pertaining to social connection, but it doesn't feel like that in real life. People suck.
 
gutonc said:
FWIW, there are actually data out there that surveillance imaging (CT, PET, MRI) in people with a history of early stage (I-III) breast cancer treated with curative intent not only does not increase rate of identification of metastatic disease over symptom based imaging but does in fact lead to increased morbidity and cost.

I mean, if we had a time machine and could go back and do a CT scan 6 months prior...maybe. if we knew what we were looking for. But just to sight a few examples, a standard contrast enhanced CT CAP or MRI has a low likelihood of picking up a primary esophageal, gastric, pancreatic or colon cancer. But picking up the mets in the liver or lung is relatively easy. So a "clean" scan is not in any way a guarantee that a cancer is not lurking.

Early cancer detection is a huge area of research, but for most cancers, imaging based screening has been a bust (CT chest for lung and mammograms for breast being notable exceptions).
Click to expand...

What do you think about the liquid biopsies?
 
finalpsychyear said:
Ideal BMI, Real cooked foods, 7-8 hrs sleep, 1 hr cardio/weights 4-5 days. get a trainer/nutrtionist. meditate. Do fasting. dont drink or smoke. Live in a low pollution area. Good social connection/relationships.

Just cured 99% of cancers and dz. But 90% of people wont do this. We live in a society that wants their cake and eat it too.
Click to expand...
Haha, look at what you just wrote. It is just not possible for the average person/family who is working 1-2 jobs a week to make ends meet. Bahahahaahahahahah
 
Porfirio said:
Haha, look at what you just wrote. It is just not possible for the average person/family who is working 1-2 jobs a week to make ends meet. Bahahahaahahahahah
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What you're hinting at is very apropos to this discussion.

As much as EM is a waste of an MD/DO, it's still a far better opportunity than what is reasonably accessible to a majority of people out there

If you can just stomach the trash tier job for 5 years while just stacking/investing aggressively, it's a near-guaranteed escape

Civil War 2 here we come
 
Porfirio said:
Haha, look at what you just wrote. It is just not possible for the average person/family who is working 1-2 jobs a week to make ends meet. Bahahahaahahahahah
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Thats a different discussion. Even those with resources would find it tough. Would be nice to see this pushed more in the states. Too much money/power in meds and food industry for change anytime soon. Will continue this circle of creating the unhealthy food that feeds the illnesses and then treat the symptoms clown show until we can't print our way into funding it. Escaping the matrix was never going to be easy but thats why we all chose it. Eventually will get there, just depends on how many game overs we suffer through.
 
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EctopicFetus said:
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Sure you may get an incidentaloma and go down a rabbit hole and get a Bx and become septic. However, more likely you will find nothing, be reassured and go about your day. Even more likely is you find some other mild finding and you can decide what to do. The screening is not cost effective which is different than being totally stupid.

We have all seen a patient with Mets and a new dx of cancer. If that same Dx was made [emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]]]] months earlier things would be different for that patient.
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I don’t think it’s more likely you’ll find nothing. If you truly have a whole body MRI, I think the likelihood of a finding of unknown significance, let alone many findings, is pretty high.
 
Does anyone know why it looks like total mumbo jumbo any time I try to quote someone?
 
Osteoth said:
What do you think about the liquid biopsies?
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Not to shift this too far off topic (as if it's been on topic for a few pages anyway), but there are 2 different test types that you're asking about here.

One is mutational testing of circulating tumor DNA (ctDNA) in a person with a known or suspected tumor in lieu of an actual biopsy. These can be faster than a biopsy or somewhat useful when a biopsy is difficult/impossible due to patient or system specific factors. Commercial tests like Guardant 360 and Foundation Liquid CDx are in this category. I personally find them more useful than just guessing what it is based on a CT scan but much less useful than an actual biopsy with tissue based NGS testing. My experience has been that the liquid biopsies don't pick up as many mutations as are present in the actual tumor (when compared side by side) and except for the most clinically obvious tumors, their ability to diagnose the primary site when you only have evidence of metastases is poor. In short, better than nothing, but there are better things.

If you're asking about blood-based multi-cancer early detection such as the Grail Galleri test, it's exciting technology, but you don't really have to read between the lines in their own manuscript to realize that it's not ready for prime time. In their big screening test of >6500 people, They had 92 positive tests, of which only 35 (a little more than 1/3) actually had cancer. This works out to a true positive test rate of 0.86%. Unfortunately, the false negative rate (negative blood test who were diagnosed with cancer within 12 months of the blood test) was 1.32%, 1.5x higher. Of the 35 true positives, 15 of them were breast, lung, colorectal and prostate, all of which have some reasonable level of evidence for standard screening procedures. So if you want to be really stringent in your definition, this test identified a real cancer in 0.3% of people in the study that would not have been picked up by standard screening when the actual cancer rate in the study was 1.8%, so it caught a little over 15% of the actual cancers. The author's own conclusion is "This study supports the feasibility of MCED screening for cancer and underscores the need for further research evaluating its clinical utility." Which translates to, "our test kind of works, but it mostly doesn't".

To be transparent, I accrued roughly 50 people to this study on my own (my institution at the time was the highest accruing to the study and the 2nd author who now works at Grail used to be at that institution). I think this technology has a lot of promise, and I imagine that there are some AI informed analysis models and testing strategies that are going to make this type of testing a standard in the next decade or so. But the currently available products just aren't there yet.

Now...aren't you sorry you asked?
 
Pinner Doc said:
Does anyone know why it looks like total mumbo jumbo any time I try to quote someone?
Click to expand...
Are you using the SDN or Tapatalk apps on iOS? There is a bug in there than the admins and tech folks have been trying to track down and fix. As I understand it, for some people, deleting the current version of that app and reinstalling the newest on (not just updating) has fixed some of the problems people have been having.

I've reported your post for escalation and testing by our admin folks.
 
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